Environmental Scan: National Snapshot of Community Mental Health Services in the Context of Regionalization

May 14, 2009

The introduction of the Local Health Integration Networks (LHINs) in Ontario has changed the landscape for planning and delivery of community mental health services and supports. Although Ontario’s approach is unique, there is much that can be learned from 15 years of experience of regionalization in other provinces. This paper provides a snapshot of the other provincial and regional contexts in which community mental health services and supports are delivered.

Executive Summary

The introduction of the Local Health Integration Networks (LHINs) in Ontario has changed the landscape for the policy, planning and delivery of community mental health services and supports. Although Ontario’s approach is unique in Canada, there is much that can be learned from approximately 15 years of experience of regionalization in other provinces.

This paper provides a snapshot of the provincial and regional contexts in which community mental health services and supports are delivered. Data were gathered through open-ended telephone interviews with key informants.

Summary of Key Findings from Provinces Undergoing Regionalization

Approaches to regionalization of health care services across Canada have varied and evolved over approximately 15 years of experience with regionalization.

The restructuring of responsibilities under regionalization has led to a reduction in capacity for mental health planning at the provincial level.

Lack of clarity regarding provincial and regional roles has meant that provincial mental health plans have not been implemented as intended, due to confusion over who is accountable for what.

The involvement of the Regional Health Authorities (RHAs) in provincial planning has often shifted discussions towards operational issues and away from provincial strategy.

Mental health services that are provided in hospitals and outpatient clinics that incorporate psychiatric services are included under all regional health structures. Community mental health services and supports are not always provided under the regional structures, but may be provided through contractual arrangements between the regional health authorities and community organizations.

Mental health services vary in type, availability and accessibility across RHAs and between provinces.

RHAs have been challenged to manage competing demands for health care within a system of finite resources. The needs of an under-funded mental health system have been in competition with acute care, home care and other health service demands. These pressures have been exacerbated by fiscal constraints, human resource shortages and increased demands on performance.

RHAs have tended to move away from protected mental health funding and towards funding mental health services from the same regional health budgets as other health services.

Contractual agreements between RHAs and community mental health agencies have proven onerous and have had a negative impact on the organization’s resources.

There is increasing emphasis on accountability, transparency and health system performance in all regional structures.

Nova Scotia is the only province with mental health care standards but it has been unable to implement them fully due to a lack of funding.

Little evidence was found of mental health system integration as a result of regionalization. Mental health and addiction services appear to be in the early stages of dialogue about integration. Integration with primary care and chronic disease management was not evident in the interviews.

Recentralization in Alberta, New Brunswick and Prince Edward Island may be in part a response to gaps created by loss of provincial capacity and the need to have more consistent approaches to service across regions.

Lessons for Ontario

Understanding and adapting to new roles at the provincial, regional and local levels is fundamental to a successful transition during regionalization. This transformation must be driven by clear provincial policy that directs and integrates the activities at the regional and local level.

Ontario’s current mental health policy is more comprehensive than many other provinces and recognizes the important role that community mental health services play in supporting the recovery of people with serious mental illness. Ontario should ensure that regionalization does not divert attention away from continuing to formulate and implement mental health policies and directions that support recovery.

The new stewardship role of the Ontario Ministry of Health and Long-Term Care (MOHLTC) continues to support and enable dialogue and consultation between ministry staff and stakeholders at the provincial level.

In Ontario, continued collaboration among provincial organizations should be encouraged and utilized to provide advice on mental health policy development, provincial system planning, standard setting and performance monitoring.

Community mental health agencies in Ontario that are small to medium size need to build capacity to be able to respond to the demands generated by their new relationship with their LHIN.

The delineation of authority, roles and functions between the MOHLTC and the LHINs needs to be clarified.

Mental health program standards are under development in Ontario. Adequate funding is necessary to support implementation of standards.

Provincial organizations need to support the sector by building capacity to help them demonstrate performance results and assist their ability to adapt to change.